What is Leprosy? Leprosy (also known as Hansen's disease after scientist who discovered it) is an infectious disease that is characterized by skin sores, progressive debilitation and nerve damage. Leprosy has been recognized in the ancient civilizations of Egypt, China, and India. When G.A. Hansen discovered it in 1873, it was the first bacterium known to be disease causing in humans. It has two common forms: tuberculoid and lepromatous (WebMD, 2011). Lepromatous is the most severe of the two forms because it produces large disfiguring lumps and bumps. Both forms are alike in that they affect the skin, the peripheral nerves, mucosa of the upper respiratory tracts and also the eyes. Leprosy is considered a chronic granulomatous disease like tuberculosis because it produces inflammatory nodules in the skin and nerves over time (Leprosy Elimination, n.d.).
The cause of the disease is a small slow-growing prokaryotic bacteria known as Mycobacterium leprae, which is an acid-fast, rod-shaped bacterium. Leprosy is not highly contagious. The only way someone could catch this disease is if this person comes in close, repeated contact with the nose or mouth droplets from someone who is untreated. Three other species can carry and in rare cases transfer Mycobacterium leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos (WebMD, 2011). The exact mode of transmission of leprosy is not known. Until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Recently the possibility of transmission by the respiratory route is being thought of a possibility. The skin and the nasal mucosa are the two portals of exit of M. leprae. The portal of entry, which is not clearly known, is thought to be the skin and upper respiratory tract (Leprosy Elimination, n.d.).
The body can respond in two ways: In tuberculoid leprosy which is the milder form (70-80% cases are tuberculoid) the body's immune cells attempt to seal off the infection to keep it from the rest of the body. However this happens in the deeper layers of the skin, hair follicles, sweat glands, and nerves can be destroyed in the process. This causes the skin to become dry and discolored and loses its sensitivity. This can involve the nerves of face, arms, or legs causing them to become enlarged and can be felt by doctors a trademark of tuberculoid leprosy.Well-defined skin lesions that are numb is the first symptom. In lepromatous leprosy (aka multibacillary leprosy) the second and more contagious forms. The body can't make a strong response to the organism and thus the organism multiplies freely in the skin. Characteristic features are chronic stuffy nose due to invasion of the mucous membranes, large nodules or lesions all over the face, sometimes the mucous membranes of the eyes, nose, and throat may be involved. The facial involvement can look lion-like in appearance (Leprosy Hansen's, n.d.).
When a person becomes infected with the bacteria that cause Leoprosy (Mycobacterium leprae), the bacteria begin to multiply within the body. After three to five years, symptoms of leprosy will usually begin. This period between becoming infected and the start of symptoms is the "leprosy incubation period." Although the incubation period is typically between three and five years, it can range from six months to several decades.Many symptoms may occur. Muscles weakness may occur followed by numbness generally in the hands, feet, arms and legs. Skin lesions may also occur with coloring that is lighter than your normal skin color. Lesions do not generally heal after several weeks to months. Symptoms usually take a long a long while to appear after coming in contact with someone with the leprosy-causing bacteria. The incubation period is known as the period between the contact with the bacteria and the appearing symptoms. The incubation period is what makes it difficult for doctors to determine when and where the person originally got sick because the disease develops slowly from six months to 40 years.Occasionally, because of the loss of feeling, the fingers and toes become mutilated and fall off, causing the deformities that are typically associated with the disease.
The incubation period of the leprosy bacillus varies anywhere from six months to ten years. On an average, it takes four years for the symptoms of tuberculoid leprosy to develop. Because of the slow growth of the bacillus, lepromatous leprosy develops even more slowly, taking an average of eight years for the initial lesions to appear. It is still not very clear how the leprosy bacillus is transmitted from person to person; about 50% of patients diagnosed with the disease have a history of close contact with an infected family member. Since untreated patients have a large number of M. leprae bacilli in their nasal secretions, it is thought that transmission may take place via nasal droplets. The milder tubercular form of leprosy may be transmitted by insect carriers or by contact with infected soil.
The incidence of leprosy is highest in the poverty belt of the globe. Therefore, environmental factors such as unhygienic living conditions, overpopulation, and malnutrition may also be contributing factors favoring the infection. It is also possible that genetic factors are involved in susceptibility to leprosy. In 2003, scientists conducting a genome scan of a large Vietnamese family with many cases of leprosy found that susceptibility to the disease was linked to region q25 on the long arm of chromosome 6. Further study indicated that the leprosy susceptibility gene lies within a region shared by two genes for Parkinson's disease. Further research may confirm that the emergence of leprosy in certain individuals is related to inheritance of genes for Parkinson's disease (MedlinePlus, 2011). Treatment
Historically there was no cure for Leprosy. Today however there are antibiotics that can be prescribed with an early diagnosis that will kill the pathogen and cure the patient.. Since 1995, World Health Organization has supplied multidrug therapy free of charge to leprosy patients in all endemic countries. The drugs used are a combination of rifampicin, clofazimine and dapsone. Unfortunately the antibiotics cannot reverse the damages to the nerves. Anti-inflammatory drugs may also be given to patients with leprosy to help control the swelling. A person should see improvements after two to three months of beginning treatment. Patients with leprosy are commonly thought not to suffer pain, neuropathic pain caused by inflammation of peripheral nerve endings is a major complication of the disease. Corticosteroids may be given to reduce the inflammation (Leprosy Elimination, n.d..
Diagnosis of Leprosy
Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. Heath workers in practice usually can pick this up in a short time. Only in rare instances is there a need to use laboratory and other investigations to confirm a diagnosis of leprosy. In an endemic country or area the person is diagnosed if have skin lesions consistent with leprosy and with definite sensory loss, with or without thickened nerves or positive skin smears. Skin lesions can be single or multiple usually less pigmented than the surrounding area and can be reddish or copper-colored. Skin lesions can be in variety such as macules or flat, papules or raised, or nodules. Usually patients tend to have sensory loss including in the lesion.
Positive skin smears: In a small proportion of cases, rod-shaped, red-stained leprosy bacilli, which are diagnostic of the disease, may be seen in the smears taken from the affected skin when examined under a microscope after appropriate staining.
A person presenting with skin lesions or with symptoms suggestive of nerve damage, in whom the cardinal signs are absent or doubtful should be called a `suspect case' in the absence of any immediately obvious alternate diagnosis . Such individuals should be told the basic facts of leprosy and advised to return to the centre if signs persist for more than six months or if at any time worsening is noticed. Suspect cases may be also sent to referral clinics with more facilities for diagnosis (Leprosy Elimination, n.d.).
How They Were Treated By Their Peers Due to the deformities from skin lesions are very disfiguring causing the infected individuals to be historically outcasted in many cultures. In the past few decades, with the rapid progress in medical science and technology, health care services have tended to become more technology oriented and expensive. At the same time a sense of dependency on the medical profession has been created. This monopoly of medical knowledge by the medical profession has resulted in the medicalization of public health. People in subtle ways are being denied the right to acquire and utilize health knowledge. In dealing with leprosy, the same phenomena have occurred. Leprosy has been treated separately and, right down to the local level, there are special leprosy workers who solely deal with this illness. Persons affected with leprosy as well as ordinary people are, unfortunately, given little knowledge about this disease. Human beings live in a community -- be it a family, clan or the larger rural or urban setting. Their well being and development are affected to a large extent by the way they are treated by these community groups and the society as a whole. Persons with physically disabling conditions in general are not fully accepted by society, and PALs even more. Often even the family members disown their own children who are affected by leprosy.
Leprosy (Hansen's Disease)
What is Leprosy?
Leprosy (also known as Hansen's disease after scientist who discovered it) is an infectious disease that is characterized by skin sores, progressive debilitation and nerve damage. Leprosy has been recognized in the ancient civilizations of Egypt, China, and India. When G.A. Hansen discovered it in 1873, it was the first bacterium known to be disease causing in humans. It has two common forms: tuberculoid and lepromatous (WebMD, 2011). Lepromatous is the most severe of the two forms because it produces large disfiguring lumps and bumps. Both forms are alike in that they affect the skin, the peripheral nerves, mucosa of the upper respiratory tracts and also the eyes. Leprosy is considered a chronic granulomatous disease like tuberculosis because it produces inflammatory nodules in the skin and nerves over time (Leprosy Elimination, n.d.).
Cause/ Transmission
The cause of the disease is a small slow-growing prokaryotic bacteria known as Mycobacterium leprae, which is an acid-fast, rod-shaped bacterium. Leprosy is not highly contagious. The only way someone could catch this disease is if this person comes in close, repeated contact with the nose or mouth droplets from someone who is untreated. Three other species can carry and in rare cases transfer Mycobacterium leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos (WebMD, 2011). The exact mode of transmission of leprosy is not known. Until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Recently the possibility of transmission by the respiratory route is being thought of a possibility. The skin and the nasal mucosa are the two portals of exit of M. leprae. The portal of entry, which is not clearly known, is thought to be the skin and upper respiratory tract (Leprosy Elimination, n.d.).
||The body can respond in two ways:
In tuberculoid leprosy which is the milder form (70-80% cases are tuberculoid) the body's immune cells attempt to seal off the infection to keep it from the rest of the body. However this happens in the deeper layers of the skin, hair follicles, sweat glands, and nerves can be destroyed in the process. This causes the skin to become dry and discolored and loses its sensitivity. This can involve the nerves of face, arms, or legs causing them to become enlarged and can be felt by doctors a trademark of tuberculoid leprosy.Well-defined skin lesions that are numb is the first symptom.
In lepromatous leprosy (aka multibacillary leprosy) the second and more contagious forms. The body can't make a strong response to the organism and thus the organism multiplies freely in the skin. Characteristic features are chronic stuffy nose due to invasion of the mucous membranes, large nodules or lesions all over the face, sometimes the mucous membranes of the eyes, nose, and throat may be involved. The facial involvement can look lion-like in appearance (Leprosy Hansen's, n.d.).
Symptoms
When a person becomes infected with the bacteria that cause Leoprosy (Mycobacterium leprae), the bacteria begin to multiply within the body. After three to five years, symptoms of leprosy will usually begin. This period between becoming infected and the start of symptoms is the "leprosy incubation period." Although the incubation period is typically between three and five years, it can range from six months to several decades.Many symptoms may occur. Muscles weakness may occur followed by numbness generally in the hands, feet, arms and legs. Skin lesions may also occur with coloring that is lighter than your normal skin color. Lesions do not generally heal after several weeks to months. Symptoms usually take a long a long while to appear after coming in contact with someone with the leprosy-causing bacteria. The incubation period is known as the period between the contact with the bacteria and the appearing symptoms. The incubation period is what makes it difficult for doctors to determine when and where the person originally got sick because the disease develops slowly from six months to 40 years.Occasionally, because of the loss of feeling, the fingers and toes become mutilated and fall off, causing the deformities that are typically associated with the disease.
The incubation period of the leprosy bacillus varies anywhere from six months to ten years. On an average, it takes four years for the symptoms of tuberculoid leprosy to develop. Because of the slow growth of the bacillus, lepromatous leprosy develops even more slowly, taking an average of eight years for the initial lesions to appear.
It is still not very clear how the leprosy bacillus is transmitted from person to person; about 50% of patients diagnosed with the disease have a history of close contact with an infected family member. Since untreated patients have a large number of M. leprae bacilli in their nasal secretions, it is thought that transmission may take place via nasal droplets. The milder tubercular form of leprosy may be transmitted by insect carriers or by contact with infected soil.
The incidence of leprosy is highest in the poverty belt of the globe. Therefore, environmental factors such as unhygienic living conditions, overpopulation, and malnutrition may also be contributing factors favoring the infection.
It is also possible that genetic factors are involved in susceptibility to leprosy. In 2003, scientists conducting a genome scan of a large Vietnamese family with many cases of leprosy found that susceptibility to the disease was linked to region q25 on the long arm of chromosome 6. Further study indicated that the leprosy susceptibility gene lies within a region shared by two genes for Parkinson's disease. Further research may confirm that the emergence of leprosy in certain individuals is related to inheritance of genes for Parkinson's disease (MedlinePlus, 2011).
Treatment
Historically there was no cure for Leprosy. Today however there are antibiotics that can be prescribed with an early diagnosis that will kill the pathogen and cure the patient.. Since 1995, World Health Organization has supplied multidrug therapy free of charge to leprosy patients in all endemic countries. The drugs used are a combination of rifampicin, clofazimine and dapsone. Unfortunately the antibiotics cannot reverse the damages to the nerves. Anti-inflammatory drugs may also be given to patients with leprosy to help control the swelling. A person should see improvements after two to three months of beginning treatment. Patients with leprosy are commonly thought not to suffer pain, neuropathic pain caused by inflammation of peripheral nerve endings is a major complication of the disease. Corticosteroids may be given to reduce the inflammation (Leprosy Elimination, n.d..
Diagnosis of Leprosy
Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. Heath workers in practice usually can pick this up in a short time. Only in rare instances is there a need to use laboratory and other investigations to confirm a diagnosis of leprosy. In an endemic country or area the person is diagnosed if have skin lesions consistent with leprosy and with definite sensory loss, with or without thickened nerves or positive skin smears. Skin lesions can be single or multiple usually less pigmented than the surrounding area and can be reddish or copper-colored. Skin lesions can be in variety such as macules or flat, papules or raised, or nodules. Usually patients tend to have sensory loss including in the lesion.
Positive skin smears: In a small proportion of cases, rod-shaped, red-stained leprosy bacilli, which are diagnostic of the disease, may be seen in the smears taken from the affected skin when examined under a microscope after appropriate staining.
A person presenting with skin lesions or with symptoms suggestive of nerve damage, in whom the cardinal signs are absent or doubtful should be called a `suspect case' in the absence of any immediately obvious alternate diagnosis . Such individuals should be told the basic facts of leprosy and advised to return to the centre if signs persist for more than six months or if at any time worsening is noticed. Suspect cases may be also sent to referral clinics with more facilities for diagnosis (Leprosy Elimination, n.d.).
How They Were Treated By Their Peers
Due to the deformities from skin lesions are very disfiguring causing the infected individuals to be historically outcasted in many cultures. In the past few decades, with the rapid progress in medical science and technology, health care services have tended to become more technology oriented and expensive. At the same time a sense of dependency on the medical profession has been created. This monopoly of medical knowledge by the medical profession has resulted in the medicalization of public health. People in subtle ways are being denied the right to acquire and utilize health knowledge. In dealing with leprosy, the same phenomena have
occurred. Leprosy has been treated separately and, right down to the local level, there are special leprosy workers who solely deal with this illness. Persons affected with leprosy as well as ordinary people are, unfortunately, given little knowledge about this disease.
Human beings live in a community -- be it a family, clan or the larger rural or urban setting. Their well being and development are affected to a large extent by the way they are treated by these community groups and the society as a whole. Persons with physically disabling conditions in general are not fully accepted by society, and PALs even more. Often even the family members disown their own children who are affected by leprosy.